Contemporary postnatal plastic surgical management of meningomyelocele.

BACKGROUND: The goals of this study were to review the outcome of the surgical procedure and hospitalization associated with meningomyelocele repair, and to examine the results of different closure strategies. METHODS: Eighty-three consecutive patients having surgery for meningomyelocele over a ten year period form the basis of this study. Thirty-two closures with a mean defect size preoperatively of 11.5 cm(2) were performed by the neurosurgeon (ADP), and fifty-one closures with a mean defect size of 28.4 cm(2) by the plastic surgeon (MFA). RESULTS: Defects up to 12 cm(2) were closed with local advancement fasciocutaneous flaps. As defect size increased, latissimus muscle flaps were added in 30 (36%) and gluteus muscle in 16 (19%). In recent years, 18 patients (21.6%) with a mean defect of 29 cm(2) were treated with overlapping of deepithelialized fasciocutaneous flaps to add an additional layer of coverage to the dural closure. There were 9 major complications, 6 requiring reoperation. There were 10 minor wound failures managed conservatively. Mean hospital stay was 24.2 days. Re-operation increased length of stay to 45 days (p < 0.0001). Minor wound problems added 6 days to mean hospital stay. Wound failure did not correlate with either defect size or closure technique. Thoracic location was associated with increased wound failure (p < 0.05). Use of a shunt did not increase morbidity. All closures remained durable after discharge. CONCLUSIONS: Location in the thoracic area predicts major wound failure and need for reoperation. Wound complications significantly increase hospital stay. The use of a variety of techniques to achieve multi-layered closures leads to durable coverage for defects of all sizes.

Effects of comorbidities and implant reinforcement on outcomes after component reconstruction of the abdominal wall.

A series of patients undergoing component reconstruction of midline abdominal wall separations was analyzed to assess the effects of comorbidities and biological implant reinforcements on outcomes. Thirty-nine patients were identified as fitting the technical definition of component repairs and having at least 12 months of documented follow-up. This group of procedures had a 67% primary healing rate, 18% and 13% rate of major and minor complications, respectively, and a total of 90% successful reconstructions after secondary procedures. Variables assessed for outcome influences included etiology of the abdominal wall separation, obesity, diabetes, hypertension, and biological implant reinforcements, including absorbable mesh and biological implants. None of these factors significantly influenced outcome, although first time repairs and reinforced repairs had suggestively higher success rates. This data suggest that comorbidities do not influence outcomes of component abdominal wall repairs, and assessments of the problem and ongoing technical refinements of the procedure should be studied further.

The plastic surgeon's guide to drugs affecting hemostasis.

The plastic surgeon is encountering an unprecedented population of aging individuals who both desire cosmetic or reconstructive surgery and may require the use of medications that alter hemostasis. The increasing use of anticoagulants and platelet inhibitors in particular can create challenges for the plastic surgeon. The purpose of this review is to familiarize the surgeon with the medications that can affect hemostasis and to suggest strategies for their use in the perioperative period. Specific case examples are presented.